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Starting a two-week block of heme-onc consults today! Given that many interns may be calling their first heme-consult in the coming days, I figured it would be helpful to share important info to have for different questions! #MedTwitter #hemetwitter #onctwitter
Day 1 - anemia workup consult:
- have the MCV handy
- try to get iron studies, retic count, B12 +/- folate ahead of the consult
- worried about hemolysis? Get an LDH, haptoglobin, and bilirubin
-let us know if things have already been tried (iron repletion, Epo, etc)
- have the MCV handy
- try to get iron studies, retic count, B12 +/- folate ahead of the consult
- worried about hemolysis? Get an LDH, haptoglobin, and bilirubin
-let us know if things have already been tried (iron repletion, Epo, etc)
Day 2 - thrombocytopenia consult:
-good med hx including new meds
-heparin exposures and 4T score
-hx of underlying liver disease?
-did the TCP develop in the hospital or was it present on admission?
-HIV and Hep C hx
-INR and PTT to assess for concurrent coagulopathy
-good med hx including new meds
-heparin exposures and 4T score
-hx of underlying liver disease?
-did the TCP develop in the hospital or was it present on admission?
-HIV and Hep C hx
-INR and PTT to assess for concurrent coagulopathy
Day 3 - anticoagulation:
- what’s the indication (DVT, PE, A-fib?)
- patients past and current anticoagulation hx including events, meds, and hypercoag work-up it done
- any renal/hepatic dysfunction that would limit which anticoagulant can be used?
- bleeding hx
- what’s the indication (DVT, PE, A-fib?)
- patients past and current anticoagulation hx including events, meds, and hypercoag work-up it done
- any renal/hepatic dysfunction that would limit which anticoagulant can be used?
- bleeding hx
Day 4 - neutropenia workup:
- was it present on admission or did it develop while inpatient?
- has the patient had neutropenia before that resolved w/o intervention?
- good med hx
- active autoimmune disease (eg SLE, RA), sarcoidosis)?
- are there other cytopenias?
- was it present on admission or did it develop while inpatient?
- has the patient had neutropenia before that resolved w/o intervention?
- good med hx
- active autoimmune disease (eg SLE, RA), sarcoidosis)?
- are there other cytopenias?
Day 5 - polycythemia workup:
- is the patient hemoconcentrated?
- the the patient have an underlying cardiopulmonary disease?
- any symptoms of hyperviscosity?
- any thrombotic events?
- send off an erythropoietin level
- discuss sending JAK2 mutation vs waiting for above workup
- is the patient hemoconcentrated?
- the the patient have an underlying cardiopulmonary disease?
- any symptoms of hyperviscosity?
- any thrombotic events?
- send off an erythropoietin level
- discuss sending JAK2 mutation vs waiting for above workup
